2015 Impact Report

OUR BEGINNING

In 2006, Susan Dix Lyons went to Nicaragua – a country she had first visited more than 15 years earlier as a young journalist covering the Presidential election of Violeta Chamorro.

During that visit, Susan and her husband, Dr. Tim Lyons, toured a struggling local hospital – and were asked to help provide equipment and supplies. Over the next year and a half, Susan worked with the hospital to coordinate the shipment of two containers of donated medical supplies. When she returned to see how the supplies were being used, however, she saw that little had changed. She was driven to find a better way to improve patient care for the impoverished.

Compelled by the opportunity and urgency she observed, but knowing that she needed help, Susan met with Cristiana Chamorro, the daughter of former President Violeta Chamorro, and Margarita Gurdián, the outgoing Minister of Health of Nicaragua. She asked if they would join her to create a healthcare project. They both said yes. In partnership with these two extraordinary Nicaraguan women, Clínica Verde was born.

In 2008, the first annual meeting of the Board of Clínica Verde convened in Managua, Nicaragua with a vision and a dream: to create a global prototype of a sustainably designed health clinic for families living in poverty that took a preventive approach to healthcare. Experts from the U.S. in medicine, design, finance and law convened with Nicaraguan physicians, politicians, and community members to work together to create a new model of care for families in need.

In January of 2012, after years of fundraising, analysis, engineering, set-backs, design meetings, and construction, Clínica Verde opened its doors in Boaco, Nicaragua, where land had been donated by the local mayor. The result of sustained, cross-cultural collaboration, Clínica Verde today serves nearly 10,000 patients per year, providing compassionate clinical care, health and nutrition education in an environment designed to support and promote wellbeing and dignity.

LETTER FROM THE CEO

In 2012 we opened our doors with a vision of health and hope. It was the culmination of a four-year partnership with the community we serve to bring Clinica Verde to life.

Our vision included high-quality healthcare for those living in need – but that was just the first step. We believed that in order to transform the lives of our cherished patients we needed to take a preventive approach to wellbeing that began with compassionate care and extended to health and nutrition education in an environment designed to support and provide dignity to those we served.

We believed in a new model of care that went beyond clinical excellence to the root equation that makes each of us healthy and whole: love, safety, food security, clean water, and access to education.

What Clinica Verde offered was wholly unique among health centers for the underserved in the region:

A staff guided by compassion and dignity for the poor

A clinic grounded in principles of human-centered design

Provision of nutrition and health education to enhance self-efficacy

Since opening and through the end of FY 2015, we’ve served more than 47,000 patients. That number is important to us, but even more important is the number of patients who engage in the activities that empower our community to improve care for themselves and their families: our educational talks, bio-intensive garden, maternal infant nutrition program, and teen peer counselor club.

In truth, this can sometimes be tricky. It’s much easier to show that we’ve vaccinated and prevented parasitic diseases in thousands of children than to prove how our education has helped prevent teen pregnancy, diversify diet to decrease childhood malnutrition, and – even more challenging – increase the self-esteem of our patients so that they have hope in the future. But we believe it’s these activities that have the greatest potential to transform long-term health behaviors and improve the lives of the families we have the honor of serving.

Because of your support, we’ve come a long way in understanding what we do well – and where we need to go. We’re working hard to document our impact so we can continue to focus our resources on the things that are most effective in transforming health.

I’m proud to share with you what we’ve accomplished in the past years, and where we are today. Most of all, I look forward to building on our successes in partnership with you to continue to bring health and hope to families living in poverty.

OUR VISIONChanging lives through health and hope.

OUR MISSIONCreating a new model of care for families in need.

We take a preventive approach to the wellbeing of our patients, providing nutrition and health education along with compassionate clinical care in an environment designed to support and improve health outcomes.

CORE VALUESWe selected our core values as a team in 2008 and have used them to guide us along the way.

We are:Sustainable
Ethical
Innovative
Compassionate

What does that mean? We treat each individual with compassion, behave ethically, work towards sustainability both environmentally and financially, and strive to create innovative solutions to stubborn challenges.

GOALS FOR 2016

We’ve chosen three big organizational goals that we aim to accomplish this year.

Fortify our Organizational Culture: Train and coach each staff member in values-based service and delivery, using empathy in the care process every step of the way; further distinguish Clinica Verde as a superior, high-touch option for care for the poor

Enhance our Reputation as a Center for Excellence in Care and Education: Build new partnerships with local organizations and increase opportunities for the community and students to engage in interactive learning in areas of nutrition, food security, and sexual reproductive health, by expanding the number of Prenatal Nutrition groups from two to four and increasing the number of teen peer counselors from 44 to 100

“With our Prenatal Nutrition Group at Clínica Verde we improve the habits and nutritional practices among pregnant women, their families and their community. We promote exclusive breastfeeding in the first 6 months of life, helping to prevent infant malnutrition in the municipality of Boaco and its rural communities.

I passionately want for all pregnant women in the community to have the information they need to help prevent and reduce risks during pregnancy, and improve their nutritional habits so the benefits multiply throughout their families and the community. I dream of this type of healthy community.

Through our first pilot I learned that there are other factors that affect and encourage good habits and practices that are beyond our scope to have a greater impact in the community – unemployment and the impoverishment experienced by the majority of the women in our program. If there are no resources or availability to purchase food, our work is limited. This reinforces the importance of our seed program and the support to create home gardens.

This program has also reaffirmed for me that the solidarity among women is unique and special. It’s especially important for each woman to share her story, her joys and sorrows. This has motivated me to continue putting even more effort into the following cycles of our program to create more shared knowledge, solidarity and hope.”

OUR IMPACT – GOALS FOR 2016

Our focus is on the highest priority health needs of the region, including reducing childhood malnutrition, reducing the rate of teen pregnancy, and increasing the number of safe, healthy and supported births among the families we serve. By partnering with mothers and children, we believe we have the greatest opportunity to improve long-term health behaviors that will strengthen individuals, communities and the world.

With that in mind, we have developed eight Key Performance Indicators (KPIs), organized by our three most important principles, that will help us track our impact. These KPIs were selected because they can be feasibly collected in a systematic manner by our staff, they can be tracked consistently over time, and they have the ability to demonstrate our long-term impact.

Ensure Access and Equity

Number of Patients Served Within ClinicTarget: 10,700 patients served

Number of Community Outreach VisitsTarget: 35 community outreach visits annually;
an estimated 5,000 rural health consults

Provide Preventive Health Services

Percent of Pediatric Patients Under 5 Who Receive a Full Set of VaccinationsTarget: 100% of children under 5 who visit the clinic receive a full set of pediatric vaccinations

Percent of Patients Given Free Eye Exams and Prescriptive LensesTarget: 25% of Clinica Verde’s patients are given free eye exams and the estimated 10% of children who need them are given prescriptive lenses

Percent of Female Patients Between 21-50 Who Are Given Pap Screenings and HPV tests
Target: 95% of Clinica Verde female patients between the ages of 21 and 50 are given Pap screenings and HPV testing (within 5 years)

Percent of Adolescents Who Graduate From Our Teen Peer Counselor Program Who Have the Skills and Knowledge to Avoid Teen Pregnancy
Target: 100% of adolescents who graduate from our teen Peer Counselor Program have the skills and knowledge to avoid teen pregnancy

Enhance Food Security

Percent of Mothers Who Can Identify Symptoms of Malnutrition and 3 Nutrient-Dense FoodsTarget: 100% of mothers can identify symptoms of malnutrition and three nutrient-dense fruits or vegetables that diversify diet and enhance home nutrition

OUR HISTORY

2007

April

Clínica Verde founded

October

First Annual Meeting of the Board in Managua, Nicaragua

2008

September

Title recorded of land in Boaco, Nicaragua donated by Mayor Vivian Orozco

Our goal is to create a center for counseling adolescents at Clínica Verde that is sustainable and replicable for other partner organizations, where the leadership team and our teen counselors serve as mentors to other health centers – and in this way reach a greater number of adolescents

–Vilma Medrano, Director of TeenSmart

Dayana Reyes García15, Teen Peer Counselor

“The Clínica Verde TeenSmart program taught me how to help other young people create a life plan for themselves. Going through the course gave me the confidence to talk about the themes of sexual reproductive health. I also was able to put into practice habits that I learned through the program: responsibility, working in a team. It’s increased my desire to serve. I feel like I have a greater commitment to myself to make good decisions about my future. I’m an example to other young people and friends because I talk to them about the obligation to protect ourselves and to not make life choices that we are unprepared for.

Having graduated from the program, I’m more confident in who I am. I feel important to be chosen to give talks to other teens – and now I’m one of the most advanced teen counselors. I am proud to be an example to my peers.”

Clinica Verde Prenatal Nutrition Pilot Project

In 2015 we launched Grupo de Bienestar Materno Infantil, a pilot project that teaches pregnant mothers how to care for their babies. The program uses interactive lectures, food-based approaches and a socio-behavioral change curriculum to teach mothers about the stages of fetal development, ways to care for the health of their child in the womb, and nutrition during the antenatal and postnatal periods and the first 5 years of life.

As a result of our program:

100% of mothers in the pilot practiced exclusive breastfeeding post-delivery

90% of mothers were able to identify three fruits and three vegetables to improve nutrition

100% of mothers were able to identify signs of malnutrition and obesity

Youth Health Counseling on Sexual Reproductive Health

Since 2014 Clínica Verde has partnered with TeenSmart International to train teen peer counselors and provide adolescents with the knowledge and skills to make responsible decisions about their sexuality and postpone sexual activity to reduce the prevalence of early pregnancy.

As a result of our program:

35 students were trained to be peer counselors in sexual reproductive health, reaching more than 200 adolescents in their communities

150 talks were given by the teen counselors in their schools and communities

Biointensive Gardening Program

Clínica Verde’s biointensive garden is an effort to teach and promote healthy eating habits and home gardening in order to decrease malnutrition, increase food security, and improve the near- and long-term public health of families living in poverty in the region we serve.

As a result of our program:

21 mothers and 10 Clínica Verde patients were involved in a new seed distribution program to enhance food security

In addition, our milestones for the year included developing partnerships with the following groups:

Instituto Nacional de Boaco to cultivate two community gardens of 25 beds

The community of Balsamo to create a garden of 16 beds at the local school

The Peace Corps, Ministry of Health and Casa Materna to provide 82 women with a four-week training on nutrition and home gardening

Roniels Fitoria SotelaHead of Maintenance, Clínica Verde

“I’m the first person among the staff to arrive at Clínica Verde each day, opening its doors. The patient is welcomed and always treated with respect and love. When a patient arrives, I say, ‘Have a seat and the young woman in admissions will be here soon to answer your questions.’ It’s important that you always treat the patient with respect and love so that they know we are nice people who want them to feel at home. Then they will return.

Clínica Verde is special and different from other clinics in every respect: infrastructure, health, and its mission and vision of service. Above all, it’s just a very nice place. I like my job maintaining the clinic because this is the work that I was made to do. I am happy and feel blessed by God to work at Clínica Verde.”

“Through this program I learned how to take care of myself during pregnancy. I didn’t know how to take care of my body during the 9 months of pregnancy, how a baby grows from month to month, and the importance of caring for yourself during this time. This program helped me a lot because I learned how to eat well and feed my baby in a healthy way, and the importance of exclusive breastfeeding. I also became part of a community of mothers who learned together.”

Maria Marbeli Diaz34, Clínica Verde Prenatal Nutrition Pilot Group

“Through the Prenatal Nutrition Program I learned what are the most nutritious foods to eat better and take care of my baby and the importance of breastfeeding. Now I know how to feed my baby and family to keep them healthy and I have a home garden to help with this.”

In 2015 Clínica Verde reduced electricity cost by 36% through the installation of solar panels.

Clínica Verde is designed to use passive cooling, with clerestory windows that help circulate fresh air. Only a few rooms, including our pharmacy and lab, use air conditioning.

FINANCIALS

2008-2015 Financials

January 1, 2015 – December 31, 2015

Clínica Verde is not just providing medical care but changing the lives of these young woman and families and providing access to other life-enhancing opportunities. The extent of the vision is admirable – and the execution has always gone beyond what I anticipated and thought possible.

“As a future physician, I hope to develop strong, trusting relationships with my patients. I also want to be a part of a community, working to improve health at both the individual and population level.
I believe that access to appropriate healthcare is a human right, and I hope to provide such care to those who need it. I have grown to understand that medical disparities don’t exist in a vacuum. They are tied to economic and social disparities, which emanate from the history of a region. Clínica Verde puts this understanding into practice by working with the underserved in an interdisciplinary clinical setting, completely immersed within the community, and learning the needs of the community from the members themselves. I truly admire Clínica Verde’s commitment to a holistic picture of health. Through their community garden, adolescent peer-mentoring program, and health education classes, Clínica Verde works to address some of Nicaragua’s most salient public health issues in addition to providing quality patient care.”

PARTNERS

Our partners help us with generous financial and organizational support and enable us to fulfill our mission and vision. These organizations raise awareness of our work and help us further our goals.

Financial Support

Amigos de Clinica Verde
Calistoga Rotary Club
Canadian Institute of Public Health Inspectors
Christadelphian Meal-a-Day Fund of the Americas
Clif Bar Family Foundation
Corporate Home by Owner
Environmental Health Foundation of Canada
Global Giving
Grace Episcopal Church
Grace Family Foundation
Henriette Fonds
The New York Community Trust
One Day’s Wages
The Pimco Foundation
Rudd Foundation
St. Johns Lutheran School
The San Francisco Foundation
Sanibel-Captiva Rotary Club
Stichting Clinica Verde
Strachan Foundation
Van Ness Feldman